1. SCI Orthotics SCI Orthotics

2. Review • Nomenclature • Spine support orthoses • Neck, ThoracoLumbarSacral • Joint support orthoses • Typically lower limb motor loss adaptations • Motor augmentation orthoses • Typically upper limb motor presence augmentation • Protection orthoses

3. Orthotic Definition • Device used to assist, resist, align or simulate function of a body part or system. • Typically applies forces to affected extremity. • Force has magnitude, direction and application point. • Effectiveness depends on all 3. • Movement = rotation, translation or combination of 2. • Torque is strength of rotational force.

4. Orthotic Nomenclature • 1971 – American Orthotic and Prosthetic Association promoted standardized nomenclature • 1972 – new language put into use

5. Committee on Prosthetic-Orthotic Education of the National Academy of Sciences • All exoskeletal devices called orthotics • Described by joints they encompass • Abbreviate each joint name to 1 letter • Combination of symbols to indicate desired control of designated function

6. Orthotic Materials • Thin metal, plastic, foam, epoxy, plaster. • Short use = low durability need • High frequency & load = high durability need

7. Spine Support • Goal is stabilization in desired plane of motion • Flex/ext, sidebending, rotation • Absolute vs. relative restriction

8. Cervical Orthoses • Halo • SOMI, molded MINERVA cervical orthosis • ASPEN, Miami, PHILLY • MNDA for weak extensors (ALS) • Headmaster collar • Soft collar

9. Cervical Orthoses • Philly: AP motion limited to 30% normal, 43% rotation, 67% side bend. • SOMI: 13-27% sagittal motion, 34% rotation, 66% side bend • HALO: believed most restrictive, least overall C-spine motion but individual “snaking” of vertebrae. • Koch – 31% sagittal motion reduction in tetraplegia, suggested intimate fit body vest was best. 1978

15. ASPENCollar

16. Miamicollar

18. MNDA

20. ThoracoLumbarSacral Orthoses • 3 point force application theory • No true immobilization, just limitation of interspinous motion • Limited sagittal control • For effectiveness, must provide “inhibitory feedback signal” over bony prominences to reduce patient movement efforts.

21. LS Orthoses • Commonly used for back pain syndromes • Little consistent data to support idea that disk pressures reduced in lifting tasks. • Nachemson A.

22. TLSO types • Jewitt • Knight-Taylor • LS corsett • Clamshell or turtleshell

29. Limb Support Orthoses • Reciprocating gait orthosis • HKAFO • KAFO • AFO

41. Motor Augmentation Orthoses • Cervical deficits can use substitution or enhancement • Upper limb’s job = terminal device (hand) placement in environment • Feeding most important! • Balanced forearm orthosis (BFO), tenodesis devices, hand & digit flexion or extension assist orthoses, built up grips for grip loss. • General environmental control units • Oromotor adaptive equipment

47. Static Position Maintenance Orthoses • Common use in SCI, CVA • Prevent contracture, maintain functional position of hand.